The 10th Annual Texas Conference on Health Disparities · “EQUITY: a dream deferred” Goals for this Presentation: 1. Define Infant Mortality and Outline the Black:White Racial

The 10th Annual Texas Conference on Health Disparities:

U.S. Black:White Racial Disparity in Infant Mortality:

EQUITY: a dream deferred

Arthur R. James MD, FACOGAssociate Professor, Department of OB/Gyn

Ohio State UniversityJune 11, 2015

“EQUITY: a dream deferred”

Goals for this Presentation:1. Define Infant Mortality and Outline the Black:White Racial

Disparity in Surviving the 1st year of life.a. Increasing B/W Ratio of infant deathsb. How long its taking Black IMR to catch up to White IMR

2. Discuss importance of looking at racial disparities through an historical lens

3. Discuss essential elements necessary to ELIMINATE disparitiesa. Emphasis on Social Determinants of Health

4.

Infant Mortality:

Definition: The death of

any live born baby prior

to his/her first birthday.

“The most sensitive

index we possess of

social welfare . . . ”

Julia Lathrop, Children’s Bureau, 1913

Slide prepared by R. Fournier RN, BSN

State of Michigan FIMR Director

According to SACIM, Infant Mortality is:Multi-factorial. Rates reflect a society’s commitment to the provision of:

1. High quality health care

2. *Adequate food and good nutrition

3. *Safe and stable housing

4. *A healthy psychological and physical environment

5. *Sufficient income to prevent impoverishment

“As such, our ability to prevent infant deaths and to address long-

standing disparities in infant mortality rates between population

groups is a barometer of our society’s commitment to the health

and well-being of all women, children and families.”

SACIM, 1/2013* = non-clinical measure

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USA IMR: 1980-2011

12.6

6.05

NCHS

52% Improvement!

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USA Total, White, and Black IMR: 1980-2011

NCHS

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USA Total, White, and Black IMR: 1980-2011

2.04

2.23

NCHS54% improvement in the w-imr and 48.6% improvement in the b-imr

“…our ability to prevent infant deaths and to address long-standing disparities in infant mortality rates between population groups is a barometer of our society’s commitment to the health and well-being of all women, children and families.”…SACIM

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USA White and Black IMR: 1980-2011

NCHS

11.42

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NCHS

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NCHS

During the 30+ years represented on this slide, the black imr in 2011 is still greater than the white imr was

in 1980…a lag time of more than 30 years! At this rate it will be 2046 before black babies born in the

USA experience the same rate of survival as white babies born today.

10.9

11.42

Erasing the Gap(s):

The Gap

Slide shared by Mrs. Cheryl Boyce

With Equity, inputs may need to be different to

achieve equal outcomes

This is EquityMDCH, Health Equity Learning Labs 2013, provided by Hogan, V., Rowley, D., Berthiaume, R. and Thompson, Y, University of North Carolina at Chapel Hill. Adapted from http://indianfunnypicture.com/search/equality+doesn%27t+mean+justice

http://indianfunnypicture.com/search/equality+doesn't+mean+justice

Health Disparity:

Defining Health Disparity:

What are “health disparities”?

“Health disparities are differences in the incidence and prevalence of mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”

NIH Strategic Plan to Reduce and Ultimately Eliminate Health Disparities, 2001

Rate A ≠ Rate B

Disparity = a difference

Two quantities that are not equal

Lynch

What’s the difference between “health

disparity” (inequality) and “health inequity” ?

Lynch

Disparities (inequalities) in health are based on

observed differences:

• Poor people die younger than rich people.

• Infants from lower socio-economic families have lower

birth weights.

• Smokers get more lung cancer than non-smokers.

• Women live longer than men.

• Black babies die at higher rates than white babies.

Lynch

Inequities in health are based on ethical

judgments/decisions about those differences:

• Should poor people die younger than rich people?

• Should infants from lower socio-economic families have lower

birth weights?

• Should smokers get more lung cancer?

• Should women live longer than men?

• Should black babies die at higher rates than white babies?

Lynch

Epidemiologists can measure health disparity or

inequality…

However, some process of socio-political discourse is

required to assess which disparities are an affront to

sense of social justice and thus require intervention.

Lynch

Healthy People 2010

Goals:

•Increase quality and years of healthy life

•Eliminate health disparities

HP 2010 Priority Areas for “Eliminating” Disparities:

• Diabetes

• Immunizations

• HIV/AIDS

• Cardiovascular disease (CVD)

• Cancer

• Infant Mortality• Decrease infant mortality rate to <

4.5/1,000

“We must eliminate disparities in health”

“For all the medical breakthroughs we have seen in the past

century, we still see significant disparities in the medical

conditions of racial groups in this country.

What we have done through this initiative is to make a

commitment - really, for the first time in the history of our

government - to eliminate, not just reduce, some of the health

disparities between majority and minority populations..”

D. Satcher, US Surgeon General

USA Black:White Infant Mortality Rates, 1950-2000:

Source: National Center for Health Statistics, 2003

Healthy People IMR Goals: (Healthy People)

Goals: HP-1990: HP-2000: HP-2010:

W-IMR: “< 9” (1988 @ 8.8)

“< 7” (1992 @ 6.9)

4.5

B-IMR: 12(2010 @ 11.6)

11* 4.5

B/W

Ratio:

1.34 1.57 1

* = as of 4/29/2014 we still have not accomplished this goal

Target Year 1990 2000 2010 2020

OverarchingGoals

Decrease mortality: infants-adults

Increase independence among older adults

Increase span of healthy life

Reduce health disparities

Achieve access to preventive services for all

Increase quality and years of healthy life

Eliminate health disparities

Attain high quality, longer lives free of preventable disease…

Achieve health equity, eliminate disparities…

Create social and physical environments that promote good health…(SDOH)

Promote quality of life, healthy development, healthy behaviors across life stages…(Lifecourse)

Topic Areas 15 22 28 42*

# Objectives 226 312 467 > 580

Evolution of Healthy People:

*39 Topic areas with objectives

USA Black:White Infant Mortality Rates, 1950-2010:

0.0

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30.0

35.0

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45.0

50.0

1950 1960 1970 1980 1990 2000 2010

Year

Death

s p

er 1

,000

liv

e b

irth

s

0.0

0.5

1.0

1.5

2.0

2.5

3.0

B/W

Rati

o

White

Black

B/W Ratio

Source: National Center for Health Statistics, 2003

Lifecourse:

Explicitly considering time

John Lynch, UoMMcGill University (7/05)

Inequalities in

birth outcome &

infant health

Childhood

Conditions

education

jobs

neighborhood

Parental health

Prevailing

Social

Policies &

Circumstances

income

We can think about

inequalities in infant

health as partly the

result of processes

acting over the

lifecourse of the parents

Lynch

Childhood

Conditions

education

jobs

neighborhood

parental

health

Inequalities in

birth outcome

infant health

Prevailing

Social

Policies &

Circumstances

income

Inequalities in

adult health

income

educationneighborhood

jobs

health

Childhood

conditions

The Lifecourse and

Health Inequalities

• Time – individual lifecourse

(Generational)

• Cohort specific effects (AA’s)

• Place specific effects

• Across Domains

Lynch

A multi-level and multi-time point model

• Many illnesses, like heart disease, stroke and cancer, have natural

histories that involve long latency periods.

• Thus, it is logical to assume that exposures earlier in life have a

role to play in the development of diseases (Barker’s Hypothesis).

• Adopting a lifecourse perspective, means trying to assess the role

of “early-life”, “life-long”, and perhaps “generational” exposures –

be they biological, psychological, behavioural or socioeconomic –

and then trying to understand how they interact and accumulate

over the lifetimes of individuals and populations to eventually

manifest as disease (Weathering Hypothesis).

A Lifecourse Approach – The Basic Idea

Lynch

Political Economy

Institutions

Discrimination

CultureHistory

Structural

Macrosocial

Factors

Genetics

Human Biology

Pathological Biomarkers

Genetic

Characteristics

Pathobiology

(including medical sequelae of

non-medical antecedent events)

Lifecourse

Conception Old Age

Individual

Characteristics

Socioeconomic

BehavioralPsychosocial

Proximal Social

ConnectionsFamilyFriends

Distal Social

ConnectionsNeighborhood Community

Lynch (2000)

Health Status

Work Work

Health Status

Social and Economic Policies

Institutions (including medical care)

Living Conditions

Social Relationships

Individual Risk Factors

Genetic/ConstitutionalFactors

Pathophysiologicpathways

Individual/PopulationHealth

Determinants of Population Health

and Health Inequalities

Kaplan, 2002

Why the B/W disparity?

Unintended

Pregnancies

Teen

Births

Access to care

Late Prenatal

Care

Higher drop-out rates

Non-compliance

What is Racism and is it a

contributor to the Disparity?

Jones CP. Levels of racism: A theoretical framework and a gardener’s tale. AJPH 2000;90:1212-5

What is racism?

A system

Camara P. Jones MD, MPH, PhD

What is racism?

A system of structuring opportunity and

assigning value


What is racism?

A system of structuring opportunity and

assigning value based on phenotype (“race”)


What is racism?

A system of structuring opportunity and assigning value based on phenotype (“race”),that

Unfairly disadvantages some individuals and communities


What is racism?

A system of structuring opportunity and assigning value based on phenotype (“race”), that


Unfairly advantages other individuals and communities


What is racism?

A system of structuring opportunity and assigning value based on phenotype (“race”), that


Unfairly advantages other individuals and communities

Undermines the potential of the whole society


Forms of Racism:

•Personally mediated

•Internalized

•Institutional

Camara Jones: “The Gardeners Tale”

Personally-mediated racism:

Differential assumptions about the abilities, motives, and intents of others, by “race”.

•These assumptions can result in…

• Prejudice and Discrimination

•Examples:–Police brutality

–Physician disrespect

–Shopkeeper vigilance

–Waiter indifference

–Teacher devaluation

Camara Jones

Internalized racism:

Acceptance by the stigmatized “races” of negative messages about our own abilities and intrinsic worth.

“There is a level in which some of us live, defeated long before we actually die because, “at the bottom of our hearts, we believe the lies racism has told about us.” (James Baldwin, in a letter written to his nephew)

•Examples:

–Self-devaluation

–“White man’s ice is colder”

–Resignation, helplessness, hopelessness

Accepting limitations to our full humanity

Camara Jones

A Girl Like Me: (excerpt, film made in 2005)

Institutionalized racism:

Differential access to the goods, services, and opportunities of society, by “race”.

• Examples:– Housing, education, employment, income– Medical facilities– Clean environment– Information, resources, voice

• Explains the association between SES and “race”

• According to Dr. V. Hogan:– Concept of “intent”= irrelevant– Can take the form of non-action in face of need

Camara Jones, V. Hogan

“The GI Bill” (A Story of Embedded Racial

Inequity)

Annie E. Casey Foundation

Philip’s Story:

Child Born Father’s GI Bill: FHA Consequences Consequences

Right After Status & VA loans for Child’s for Child’s

WWII Education Well-being in

Adulthood

Low-income, White Able to use Family borrowed Philip gets

White veteran, high low-interest from home equity professional

school mortgage to support child’s job, buys own

diploma, from provisions to college education house,

Philadelphia move family (first in family to inherits

from public go to college) appreciated

housing to house when

segregated father dies

suburban

home ownership

The Annie E. Casey Foundation

Thomas’s Story:




Adulthood

Low-income, Black Could not access Family could not Thomas works

Black veteran, high home loan b/c of afford to send in minimum

school racially-restrictive child to college; wage jobs,

diploma, from underwriting high school continues to

Philadelphia criteria; family diploma is from live in family

remained in rental under-resourced home,

housing in the city segregated school considers

joining the

Army, has to

borrow $

when father

dies to give

him decent

funeral


Juan’s Story:




Adulthood

Low-income, Latino Could not access Family could not Juan works

Latino veteran, high home loan b/c of afford to send in minimum

school racially-restrictive child to college; wage jobs,

diploma, from underwriting high school continues to

Texas criteria; family diploma is from live in family

remained in rural under-resourced home,

rental housing language marries

segregated and newcomer

racially Latina, sends

segregated part of

school family’s limited

income to her

extended family

in Mexico


Fast Forward to Today . . .

Philip’s Children: Thomas’ and Juan’s Children:

Philip gives children his father’s They have no houses to

appreciated house inherit

They live in thriving communities They live in disinvested communities

Their college education’s paid by At work, they complete college on work

home equity study and student loans, with

subsequent starting debts to pay back

Philip establishes trust fund Thomas and Juan have few personal

assets to leave grand children


These stories followed only one aspect of the GI Bill: home loans. If job training, educational support,

and small business loans were also tracked, additional layers of unequal opportunity would be revealed.

“The record is very clear that instead of seizing the opportunity to end institutionalized racism, the

federal government did its best to shut and double seal the postwar window of opportunity in African

Americans’ faces. It consistently refused to combat segregation in the social institutions that were key

for upward mobility: education, housing, and employment. Moreover, federal programs that were

themselves designed to assist demobilized (returning) GIs and young families systematically

discriminated against African Americans. ” (Paula S. Rothenberg, White Privilege: Essential

Readings on the Other Side of Racism)

Social policy created over 60 years ago continues to have a disparate impact today and therefore

challenges the assumption that discrimination is a thing of the past. Past discrimination has ongoing

consequences for today’s population because benefits and disadvantages accumulate over time…from

one generation to the next.

Racism and the GI Bill:

Bottom Line:

In America, being classified as Black, Asian, Native American or Latino has never carried, and still doesn’t carry, the same advantages as being classified as White.

–The “advantage” of being White, and the “disadvantage” of belonging to other ethnicities is often measured by SES.

–Our usual characterization of ethnic minorities emphasizes the consequences of their disadvantages and suggest that they are the result of basic group-level flaws…relative to Whites. We rarely emphasize the substantial advantages Whites have preferentially provided to themselves…often at the expense of ethnic minorities.

Annie E. Casey Foundation/ A. James

What are Embedded Racial Inequities?

the accumulated advantages for whites as a group

the accumulated disadvantages for people of color as a group.

produced by public and private sector policies and practices (that preferentially provide

advantage to one group while simultaneously exposing another group to disadvantage).

Annie E. Casey Foundation

Embedded Racial Inequities?Their effects are reinforced by:

1) Dominant U.S. norms and values

2) Differential perceptions and images of people of color and whites

U.S. Declaration of

Independence The second paragraph of America's

founding document states:

"We hold these truths to be

self-evident, that all men are

created equal, that they are

endowed by their Creator with

certain unalienable rights, that

among these are life, liberty

and the pursuit of happiness."

However, events like Hurricane Katrina, circumstances like USA incarceration rates, police killings of black males, & the persistent racial disparity in birth outcomes remind America that not all of us benefit from this Declaration equally…

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Socioeconomic position, race/ethnicity and gender all structure the likelihood

of multiple exposures at multiple points in time – over the entire lifecourse

from conception to old age.

It is this life-long cascade of interacting multiple exposures, balanced against

available resources, that are the important determinants of how social

inequalities leave their imprint as health disparities.

Poverty and Race are intertwined…with each making the other worse.

Racism represents a particularly damaging and pervasive exposure. For the

poor, it is the venom in the bite of poverty. It is intricately woven into every

domain of American life and has cumulative detrimental effects throughout an

individual’s lifetime, across all domains, and across generations.

The Basic Idea

Lynch/James

History:

“The reason black people are so far behind now is not (so much) because of now, it’s because of then.” Clyde Ross

The Case for Reparations, The Atlantic Journal(http://www.theatlantic.com/features/archive/2014/05/the-case-for-reparations/361631/)

The importance of looking at disparity through an historical lens…

American Slavery: 1619-1865

The bound labor of at least twelve generations of black people”…

“Slavery was a coercive system sustained by the mobilization of the entire society, and its maintenance rested on the use of unimaginable violence and the constant threat of violence.”

Slavery and the Making of America

Jim Crow: 1865-1964 Jim Crow was the name of the racial caste system which operated between 1865 and the mid-1960s. Jim Crow was more than a series of rigid anti-Black laws. It was a way of life. Under Jim Crow, African Americans were relegated to the status of second class citizens. JimCrow represented the legitimization of anti-Black racism. Many Christian ministers and theologians taught that Whites were the Chosen people, Blacks were cursed to be servants, and God supported racial segregation. Craniologists, eugenicists, phrenologists, and Social Darwinists, at every educational level, buttressed the belief that Blacks were innately intellectually and culturally inferior to Whites.

African American Experience: 1619-2015

Time Span: Status: Years: % U.S.

Experience:

1619-1865 Slaves:“Chattel”

246 62.1%

1865-1964 Jim Crow: virtually no

Citizenship

rights

99 25.0%

1964-2015* “Equal” 51 12.9%

1619-2015 “Struggle”

“Unfairness”

396 100%

* USA struggles to transition from segregation & discrimination to integration of AA’s

l l

246 yrs.

62% of time

99 yrs.

25% of time

51 yrs.

13% of time

*CRA: Civil Rights Act art james

Time-line of African American Experience:

87% of the AA experience either as Slaves or under Jim Crow

1968: Kerner Commission Report

Released in 1968, the KernerCommission’s Report goalswere to:• Reduce Poverty• Reduce inequality• Reduce Racial injustice• Reduce crime• Reduce fear• Create responsible media

that was less controlledby Corporate interests

The Commission said it was“time to make good the Promises of AmericanDemocracy for all citizens –urban and rural, White and Black, Spanish surname,American Indian and every minority group”

Kerner Commission: 1968National Advisory Commission on Civil Disorders

• Segregation and poverty have created in the racial ghetto a destructive environment totally unknown to most white Americans.

• What white Americans have never fully understood but what the Negro can never forget--is that white society is deeply implicated in the ghetto. White institutions created it, white institutions maintain it, and white society condones it.

• It is time now to turn with all the purpose at our command to the major unfinished business of this nation. It is time to adopt strategies for action that will produce quick and visible progress. It is time to make good the promises of American democracy to all citizens-urban and rural, white and black, Spanish-surname, American Indian, and every minority group.

• Our recommendations embrace three basic principles:1. To mount programs on a scale equal to the dimension of the problems: 2. To aim these programs for high impact in the immediate future in order to

close the gap between promise and performance; 3. To undertake new initiatives and experiments that can change the system of

failure and frustration that now dominates the ghetto and weakens our society.

Kerner Commission: 1968National Advisory Commission on Civil Disorders

One of the first witnesses to be invited to appear before this Commission was Dr. Kenneth B. Clark, a distinguished and perceptive scholar. Referring to the reports of earlier riot commissions, he said:

I read that report. . . of the 1919 riot in Chicago, and it is as if I were reading the report of the investigating committee on the Harlem riot of '35, the report of the investigating committee on the Harlem riot of '43, the report of the McCone Commission on the Watts riot…(and today

he might add the Department of Justice’s Report on the Ferguson Police Department)

I must again in candor say to you members of this Commission--it is a kind of Alice in Wonderland--with the same moving picture re-shown over and over again, the same analysis, the same recommendations, and the same inaction.

“-it is a kind of Alice in Wonderland--with the

same moving picture re-shown over and over

again…

the same analysis, the same

recommendations, and the same

inaction.”

Dr. Kenneth B. Clark

Infant Mortality:

Premature Births

Congenital AnomaliesSUID

Maternal pregnancy Complications

Placental or cord anomalies

Arthur R. James

Infant Mortality:

Premature Births

Congenital AnomaliesSUID

Maternal pregnancy Complications

Placental or cord anomalies

Social Determinants of Health/Lifecourse

Arthur R. James

Disparities:

Lower graduation rates

No Insurance

Fatherless

households

Poverty

Racism

Limited Access

to CareUnder-

Education Family Support

Teen Births Nutrition

Weathering

Stress

SmokingSubstance Use

Poor Working Conditions

Housing

NeighborhoodsUnemployment

Hopelessness

Disparities in Birth Outcomes:

A. R. James

“Medical baggage”

Incarceration rates

Social Determinants of Health:

Policies

Medical Problems:

EQUITY? We keep knocking on this door…

• The Civil War:• And during my life time…

• Brown vs. Board of Education (1954)• Sit-in Movement of the 1960s• Freedom Riders• Birmingham Protests• The March on Washington• Dr. Martin Luther King, Jr• Civil Rights Act (1964)• Mississippi Freedom Rides• Selma to Montgomery March• Voting Rights Act (eroded)• Race Riots of the 1960s• Kerner Commission Report (1968)

• No Action• “Black Power”, Malcolm X• Heckler Report (1985)• Affirmative Action (now, essentially gone)• Unequal Treatment (2002)• Current Urban Unrest…Ferguson, Baltimore… Black America

We find all kinds of excuses to avoid eliminating racial disparities…To achieve equity in infant mortality, we must muster the courage to go through this door.

Racial Disparities

Arthur R. James MD

Racial Disparities: we made it this way?

We often perceive racial health disparities as consequences of “nature”. As such, we convince ourselves that these differences are “fixed” or “hardwired”; a part of what is different about us as people and therefore cannot be changed.

Similarly, we also often see America as it is instead of an America as it should be…and we accept the difference between the two as “normal”.

However, these disparities are differences that we created, differences that occur as a consequence of systems that we put into place. Therefore, we know they can be changed and would suggest that their persistence is in part because of our unwillingness to “undo” what we have done.

A R James

SDOH Approach:

What causes health inequities?

“The social determinants of health are mostly responsible for health

inequities - the unfair and avoidable differences in health status seen

within and between countries (and between different population

groups).

The structural roots of health inequities lie within:

• education,

• taxation,

• labor and housing markets,

• urban planning,

• government regulation,

• health care systems,

All of which are powerful determinants of health, and ones over which

individuals have little or no direct personal control but can only be

altered through social and economic policies and political processes.”

WHO Commission on the Social Determinants of Health

“…a moral obligation, a matter of social justice.”

“The medical profession (and Public Health) seeks not only to understand but also to

improve things. (But) Many professionals feel queasy about the prospect of social

action to improve health…because it smacks of “social engineering.”

Yet, a physician faced with a suffering patient has an obligation to make things better. If

she sees 100 patients the obligation extends to all of them. And if a society is making

people sick? We have a duty to do what we can to improve the public’s health and to

reduce health inequalities in social groups where these are avoidable and hence

inequitable or unfair. This duty is a moral obligation, a matter of social justice.”

Marmot, Health in an Unequal World

Many (most) of our Policy Prescriptions and Programmatic

Interventions: try to help families “circumvent” obstacles…

Most of these

programs help

In some cases, they

make a huge difference

BUT…most programs represent

temporary solutions. Once

pregnancy ends, we return

families to the same

circumstances that required

help in the first place.

art james

Education Health & Food Social Services Child & Family

Services

Mental Health

& Probation

Mom Dad 9 year old 5 year old Mom’s sister

Boyfriend

in trouble

Baby 1 1/2

• Medi-Cal – EPSDT

• Healthy Families Parent Expansion

• Child Health & Disability Program

• Expanded Access Primary Care

• Trauma Case Funding

• Co-payments for ER Services

• Child Lead Poisoning Prevention

Program

• HIV/AIDS Prevention & Education

• Breast Cancer Screening

• Food Stamps

• WIC

• TANF

• GAIN, CAL Learn,

Cal WORKS, etc.

• School-Based MH

Services for Medi-

Cal Kids

• Probation Officers

in Schools

• Cardenas-Schiff

Legislation

• Health Care

Through Probation

• Mental Health

Evaluations

• Juvenile Halls

• Child Care – CCDBG, SSBG, Cal

WORKS Child Care, etc.

• After-School Programs – 21st

Century Learning Centers, etc.

• Promoting Safe & Stable Families

• Child Abuse & Neglect Programs

• Foster Care – Transition,

Independent Living, Housing, etc.

• Adoption Assistance, Adoption

Opportunities

• Public Schools

• ESEA, Title I

• School Lunch & Breakfast

• Head Start

• IDEA

• After-School Programs

• Textbook Funding

• Tests & Achievement

• Teacher Issues

• GED

Ch

ildren

’s Services in LA

Co

un

ty Sou

rce: Margaret D

un

kle, IEL

YMP Component & BMA Element:

DEVELOP & IMPLEMENT STRATEGIES

Why treat people’s illnesses without changing the

conditions that made them sick? (WHO Commission on Social Determinants of Health, 2008)

A Social Determinants approach: challenges us

to “eliminate the obstacles”

Ob

sta

cle

s:

art james

We are often asked...which Social Determinants

to improve?

Teen P

regnancy

Und

er re

so

urc

ed

co

mm

unity

art james

…because 400 years is enough!

2019: “Mother Mattie Bennett Plan”…because 400 years is enough!

• In just 4 years this Nation will acknowledge the 400 year anniversary of the arrival

of Africans to the shores of America.

246 years as Slaves, 99 years under “Jim Crow”, 51 years (13%) since the

Civil Rights Act…

AA’s have never had equality – in fact, we have had marked inequality – so

why should we strive for health equity? Why should we care? Why now?

• We cannot continue to allow black babies to die at 2-3 times the rate of

whites, or a black maternal mortality rate that is 3-5 times the rate of other

groups.

• It is wrong to accept that we have to wait another 35 years before black

babies born in our country have the same survival opportunity as white

babies born today.

• 400 years of this is enough…

2019: “Mother Mattie Bennett Plan”

• Call to Action:

Challenging national MCH leadership to address racial disparities by

developing a comprehensive plan for the elimination of disparities in

infant mortality and introduce that plan to the nation by 2019!

Comprehensive:

• So needs to address the clinical and non-clinical contributors to

compromised birth outcome.

2019…

because our mothers,

fathers, and our babies

need our help…

…because 400

years is enough!

They had a dream…

What happens to a dream deferred?

Does it dry upLike a raisin in the sun?Or fester like a sore –

And then run?Does it stink like rotten meat?

Or crust and sugar overLike a syrupy sweet?

Maybe it just sagsLike a heavy load

Or does it explode?

Harlemby Langston Hughes

Thank You

[email protected](614) 293-4929

Documents

The 10th Annual Texas Conference on Health Disparities · “EQUITY: a dream deferred” Goals for this Presentation: 1. Define Infant Mortality and Outline the Black:White Racial